2000-753 TOWN OF OUEENSBURY
742 Bay Road, Queensbury, W 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 76142%
CERTIFICATE OF COMPLIANCE
Permit Number. P20000753 Date Issued: Thursday, September 28, 2000
This is to certify that work requested to be done as shown by Permit Number P20000753
has been completed.
Tax Map Number: 523400- 126--OWOOQ1-414-001-0040
Location; 383 LUZERNE Rd
Owner. ALAN DE CESARE
This structure may be used as a.
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
( )a; d A7
Director of Buikling & Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road, Queensl7ury, NY 12804-5902 (518) 761 -8201
Community Development - Building & Codes (518) 761-8256
y
BUILDING PERMIT
Permit dumber: P20000753 Application Number: A20000753
7'ax Map No. 5 23400- 1 26-000-000 1 -0 1 4-001 -0000
permission is hereby granted to: ALAN DE CESARE
For property- located at: 383 LUZERNE Rd
in the Town of Queensbury, to construct or place
at the above to
in accordance with at
together with plot plans and. other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensdaury Coning
Ordinance. Type of Construction aloe
Owner Address: ALAN DE CESARE Septic Alteration Residential
383 LUZERNE Rd Total value
QUEENSBURY, NY 12804
Contractor or Builder's Name / Address Electrical Inspection Agency
DRELLOS
NY
Plans & Specifications
2000-753
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES, Thursday, September 26, 2002
(ifa longer period is`arequired, an application for an extension must be made to the code Enforcement officer
of the Town of Queensbury before the expiration date,)
Dated at the Town of Queensbu Tuesd y, September 26, 2000
SIC�NFL7 13Y far the 'fo�crx of Qucensbury.
Director of Building .Qx e orcemerxt
- Septic stem Disposal S
Application far Permit p p y
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1 . OWNER INFORMATION: JJ A ........................................................ .,,._.............._,,,,,,,-,........................-..........
,.,,.,-;
2 0-
/� office3C
Location of installation. Q 1 - l F
E File Permit No. .�o o o ` 713
Tax Map No. Fee Paid
Owner's Name:
+IT ! f C"' .fJ 4e c L' 1� t ICJ �/It7-f 1
Address: 3 Lf c= J ''� r A (0 / _ 1 y , 1
2. INSTALLER'S NAME AJ t J`Y�C/ + � '�" PHONE NO.
3 . RESIDENCE INFORMATION: (circle year o(dwelling, indicate 9 bedroom(s) and multiply # of
bedrooms with applicable ,gallons per bedroom to equal total daily flow)
Year of House: No of Bedrooms x Computation Total Daily Flow
1980 or older x 150 gaUbdrm = '0 '0
1980 — 1991 x 130 gaUbdrm =
1991 — present x 110gaUbdrm =
Garbage Grinder Installed yes . f no - -- : 2 u u a
Spa or Whiripool Installed yes f no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
Tppqaraphy SD4-Nature Ground Water Bedrock or llnpervious Material Domestic Water Supply
ol/ scr at what depth at what depth 3rni
Rolling oam feet feet well
.Steep slope clay ifwell; water supply
�% slope other from any septic-system
depth: absorption it
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5 . PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect (unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: [000 gallon (min. size -1, 000 gal.)
Tile Field: each trench ��JF? Total System Length:
Seepage Pit(s): number of size of each: - fl by
Size of Stone to be used: # �_ / depth or thickness feet
Bed System Size: x
Alternative System: length andlar size
6. HOLDING TANK SYSTEM: Of required)
Number of tanks: I Size of each.: gallons 1 TOTAL Capacity. gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
?. SIGNATURE & INFORMATION FOR RESPONSIBLE PERSON (please read)
For your protection, please note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant, shall be void-
I have read the regulations with respect to this application and agree to abide by these and all
regyuir�eme a Town of Queensbury Sanitary Sewage Disposal Ordinance.
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TOWK �iEMSBURY
SUILDIKG _& CODE EKFORCEW-KT
742 gay Road
Qoeensbury_ MY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name L' �!
Location 73T�
q,y2 e
[late Permit
SOIL TYPE : Sand Loam-ClaY-
Results of Per of ati on Test-
{ if applicable Rate-Ki nute/ Inch a
TYPE OF SYSTEM:
?ABSORPTION FIELD . Total '
Length of each tr chi --- ---�
Depth of trenches o
Size of stone
SEEPAGE PITS : umber �,__ _ f
Size - ft , x —
Stone size _
e me �b
PIPIKG: D
Bldg . to Tank 1A 4
Tanis to Dist . Box �� {
Dist . Sox to Field/ Ye o ar a
Openings Sealed?
LOC.ATIOR/SEPARATION f t
Foundation to Tank Absorption et
Foundation to Absorp et
Separation Of Pits O
Conforms as per Plot Plan OF S
L YSTEM ON PROPERTY.:
( circle _ Ri ht Side
Rea
Front - r - Left Side g
Mi ddl e - Mi ddl a 'Rear
COF" MTS:
)FS
SYSTEM USE APPROVED :
NO
Arriv"ed= ���
Departed:
Building Inspector
i
k
I
,
� A
r
f
1, �d , ,:
pl a
G 5;?2r7 Or nbserved, or believe I saw evidencA
s ;<<..h as houses, wells, trees, fences, etc.
-f� � ( U E Y ,�- on this document. 1 also represent that I ha
' ovally measur a dist s set forth on the
BUILDING &
REVIEWED B S 1 G ffAT0 R
DATE